In an unwitnessed water-related incident, which condition should the EMT assume may be present?

• A. Cold-water immersion.
• B. Alcohol intoxication.
• C. Possible spinal injury.
• D. Air embolism.

Answer: (C)

In an unwitnessed water-related incident, the most important precaution is to protect the spine. You don’t know how the person entered the water or what injuries occurred, so there’s a real risk of spinal trauma that could be worsened by movement. The safe and practical approach is to assume there may be a spinal injury and manage accordingly: keep the head and neck aligned, use manual stabilization, and immobilize on a rigid backboard during extraction and transport. This minimizes the chance of causing or worsening neurological damage.

Cold-water immersion can happen, but it isn’t something you can assume in every case, and spinal protection remains the priority. Alcohol intoxication might be present and can affect how you assess and communicate, but it doesn’t override the need to prevent spinal movement. Air embolism is a potential complication in water events, especially with rapid ascent or certain breathing injuries, but it isn’t the default assumption guiding the initial management as strongly as suspected spinal injury.